Improve EPSDT Service Quality Through Meaningful Use of HIT

Xiaohui Zhang, Ph.D., Chief Scientist & Technology Strategist, STCMark Shishida, Executive Vice President, Cognosante

Seonho Kim, Chief Architect, ApeniMed, Inc.

Presented at:

Medicaid Enterprise Systems Conference 2012, Boston, MA

This white paper contains data that shall not be duplicated, used, or disclosed in whole or in part without the express permission of Cognosante. Copyright© 2012.

Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

Contents

WHO WE ARE AND WHAT WE DO..............................................................................................................1

HIGHLIGHT OF THE PRESENTATION............................................................................................................1

EPSDT – THE PEDIATRIC COMPONENT IN MEDICAID..............................................................................1

HEALTH CARE BENEFITS.................................................................................................................................2

STATE ADMINISTRATIVE SUPPORT SERVICES....................................................................................................2

CHALLENGES IN EPSDT MANAGEMENT AND DATA MONITORING..........................................................2

EPSDT DENTAL PERIODICITY SCHEDULES BY STATES – SOME STILL NOT AVAILABLE......................................3

SUMMARY OF MEDICAID ENROLLMENT CHANGE 2000 – 2011.........................................................................4

2011: MEDICAID AND CHIP ENROLLMENT CHILDREN IS ABOUT 83% OF TOTAL MEDICAID ENROLLMENT......5

CURRENT EPSDT DATA MONITORING AND CHALLENGES.......................................................................6

AN ILLUSTRATION OF CURRENT EPSDT DATA MONITORING BY ANNUAL REPORT FORM-416...............................7

DISCONNECTIONS IN THE CURRENT MEASUREMENTS...............................................................................7

A CLOSE LOOK AT THE LATEST NATIONAL EPSDT REPORT DATA......................................1

SUPPORT EPSDT IN ERA OF MEANINGFUL USE OF HIT.............................................................6

SOME QUESTIONS WE HAVE BEEN ASKING...............................................................................................1

LEVERAGE THE MU OF HIT AND CHIPRA AND OTHER INITIATIVES.....................................................2

EXAMPLE OF LEVERAGE HEALTHDATA.GOV FOR (MEASURE-3) PERCENTAGE OF LIVE BIRTH WEIGHTING LESS THAN 2500 GRAMS....................................................................................................................................3

EASY TO QUERY, EXPORT DATA AND BETTER SUPPORT MEDICAID MANAGEMENT...........................................4

EXAMPLE – CHILDHOOD IMMUNIZATION STATUS (MEASURE 5)..............................................................4

EXAMPLE : CHILDHOOD IMMUNIZATION STATUS REPORT.......................................................................5

THE CONCLUSION AND DISCUSSIONS..........................................................................................................7

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

WHO WE ARE AND WHAT WE DO

Scientific Technologies Corp. (STC)

Leading PH IT solutions in 24 years, supporting 16 states immunization registries with 700+ HL7 links, 17,000+ providers, 24 M patients

STC has supported disease surveillance in 10 states, NYC and WDC

Cognosante

Healthcare IT company serving more than 40 Medicaid, EPSDT and CHIP programs for over 25 years

Expert in Health Information Exchange, assisting ONC with CONNECT architecture & standards

ApeniMED

Provides clinical networking interoperability solutions

An industry-leader in HIE and federal agency connectivity using the NwHIN

HIGHLIGHT OF THE PRESENTATION

Introduction to EPSDT and a snapshot of its beneficiaries

Current EPSDT service and quality monitoring

The major challenges and the gaps

Better support EPSDT with the initiatives in MU of HIT

The historical opportunity for EPSDT in ARRA/HITECH with EMRs, EDRs, PHRs and HIE efforts

“Healthdata.gov “and initiatives

Improve EPSDT delivery through leveraging the Core Set of Children’s Healthcare Quality Measures

Examples of integrated EPSDT management tool in new quality measures

EPSDT – THE PEDIATRIC COMPONENT IN MEDICAID

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. A legal standard of coverage and access for low-income children

EPSDT has remained a central component of Medicaid, because of the operational and financial capacity it gives states to create appropriate pediatric health care systems (its ability to finance early, preventive, and on going healthcare for children at medical and social risk remains unparalleled in public or private health insurance).

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

Health Care Benefits

Periodic assessments of children’s growth and development in accordance with accepted pediatric assessment standards, including:

Unclothed physical exam incuding a nutritional assessment; An assessment to determine a child’s overall physical, mental, and developmental health (the

developmental assessment); Health history; Laboratory services as needed, including assessment of blood lead levels; Immunizations in accordance with the recommendations of the Advisory Committee on the

Immunization Practices; and Anticipatory guidance.

Interperiodic (as needed) assessments.

Comprehensive vision, dental, and hearing services in accordance with reasonable professional standards.

All medically necessary dagnostic and treatment items and services that fall within the definition of medical assistance.

A preventive standard of medical necessity that specifies “early” coverage to “correct or ameliorate” physical and mental conditions in children.

Coordination with related programs.

State Administrative Support Services

Information about EPSDT and the value of preventive health care.

Provision of scheduling and transportation to families who request services in order to ensure the timely provision of care.

Provision of reports to the United States Department of Health and Human Services regarding the number of children referred for corrective treatment, and the state’s results in attaining federally set participation goals.

—From EPSDT at 40 by CHCS

CHALLENGES IN EPSDT MANAGEMENT AND DATA MONITORING

State varying well-child visiting periodicity schedules and the visit documentation forms

Most states follow AAP Bright Future for age groups in 0-11 months, 1-4 years, 5-10 years old

Age 12-21 years old

36 states require annual preventive visit

12 states require a visit every two years

One state requires a visit every four years

States use different forms

State varying separated dental visiting periodicity schedules

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

EPSDT Dental Periodicity Schedules by States – Some Still not Available

American Academy of Pediatric Dentistry Website 8-10-2012

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

Summary of Medicaid Enrollment Change 2000 – 2011

From Kaiser Commission of Medicaid Facts: Medicaid Enrollment June 2011 Data

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

2011: Medicaid and CHIP Enrollment Children is about 83% of Total Medicaid Enrollment

Reference: 2011 CHPRA Annual Report

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

CURRENT EPSDT DATA MONITORING AND CHALLENGES

State Medicaid agencies are required to report annually on EPSDT services (CMS Form-416)

The annual report provides basic information for weather the care is received by age groups and basis of Medicaid eligibility

The number of children eligible

90 continuous days (new)

The number of beneficiaries who receive

Medical screens / dental screens

The number receive diagnostic or treatment services

The number of referred for corrective treatment services.

The data in current EPSDT measures

Claim based

Paper based

Participant ratio and screen ratio

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Improve EPSDT Service Quality through Meaningful Use of HITAugust 2012

Little about the content of care

An illustration of current epsdt data monitoring by annual report form-416

DISCONNECTIONS IN THE CURRENT MEASUREMENTS

Service quality measurement

Service completeness

Examples of FORMs (content of care at dif ages)

Service availability

Outreach (identify and enroll children eligible for Medicaid / CHIP)

Make the service available for the eligible children

Population health outcomes

Children at risks

Chronic conditions

Mental health issues

Referrals and follow up treatment

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Improve EPSDT Service Quality through Meaningful Use of HITDate

A CLOSE LOOK AT THE LATEST NATIONAL EPSDT REPORT DATA

Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.1

Improve EPSDT Service Quality through Meaningful Use of HITDate

Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.2

Improve EPSDT Service Quality through Meaningful Use of HITDate

Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.3

Improve EPSDT Service Quality through Meaningful Use of HITDate

Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.4

Improve EPSDT Service Quality through Meaningful Use of HITDate

Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper.5

Improve EPSDT Service Quality through Meaningful Use of HITDate

SUPPORT EPSDT IN ERA OF MEANINGFUL USE OF HIT

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Improve EPSDT Service Quality through Meaningful Use of HITDate

SOME QUESTIONS WE HAVE BEEN ASKING

How to improve the EPSDT service quality

Improve the service availability, accessibility and service quality

Improve the EPSDT management efficiency and lower the cost (such as the coordinated integrated eligibility and enrollment systems for Medicaid, CHIP and HIX)

How to help providers improve performance

Improve the service efficiency by leveraging e-data and HIE, such as EMR data and EDR data

Improve the service completeness by clinical support systems with EPSDT workflow

How to improve the Medicaid children health outcomes through the new initiatives

How to leverage the chart review data captured in EPSDT visiting to Identify the population health issues

How to better support the early preventive healthcare

How to construct the coordinated and integrated EPSDT service systems by leveraging the new initiatives

Better support the continuous care through the HIE effort

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Improve EPSDT Service Quality through Meaningful Use of HITDate

LEVERAGE THE MU OF HIT AND CHIPRA AND OTHER INITIATIVES

ARRA/HITECH – historical opportunities for improving EPSDT

Rapidly adopted EMRs and extensive HIE efforts

Lower volume thresholds for M.U. payments to Medicaid pediatricians (20% of Medicaid patient volume)

Leadership at Federal Level

New policy and new funding – CHIPRA quality measures

HIT impact on care for children

Goals

Improve the EPSDT delivery and service quality through integrating CHIPRA and ARRA

Improve the Medicaid children health outcomes

Selected Examples with Illustrated Approaches

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Improve EPSDT Service Quality through Meaningful Use of HITDate

Improve outreach and enrolling all eligible individuals by healthdata.gov

Improve EPSDT service quality by leveraging Initial Core Set of Health Care Quality Measures for Children in Medicaid and CHIP

Develop a high performance info system that integrates with Enterprise Medicaid, HIE and HIX, as well as EMRs

Example of Leverage Healthdata.gov for (Measure-3) Percentage of Live Birth Weighting less than 2500 grams

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Improve EPSDT Service Quality through Meaningful Use of HITDate

Easy to Query, Export Data and Better Support Medicaid Management

EXAMPLE – CHILDHOOD IMMUNIZATION STATUS (MEASURE 5)

Percentage of children that turned 2 years old during the measurement year and had specific vaccines (measured in rate of each of 10 vaccine and 9 combination)

Continuous enrollment

12 months prior to the 2nd birthday,

No more than one gap in enrollment of up to 45 days

No more than a one-month gap if the enrollment varying monthly

The denominator

A systematic sample from the eligible population

Exclusion: children have contraindication for a specific vaccine

Data source: administrative or hybrid

EXAMPLE : CHILDHOOD IMMUNIZATION STATUS REPORT

(Core Set Measure-5)

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Improve EPSDT Service Quality through Meaningful Use of HITDate

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Improve EPSDT Service Quality through Meaningful Use of HITDate

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Improve EPSDT Service Quality through Meaningful Use of HITDate

THE CONCLUSION AND DISCUSSIONS

EPSDT has maintained as a central component in Medicaid

The initiatives in MU of HIT and CHIPRA quality measures have provided tremendous opportunities for improving EPSDT delivery and service quality

EPSDT should take advantage of rapidly adopted EMRs and HIE effort

Develop EPSDT module in pediatric EMRs

Improve patient safety

Advance the standards of care

Integrate EPSDT with HIE to support care coordination

Share the data among pediatricians, PCP and dentists

An integrated EPSDT information system in the state Medicaid management could help

Outreach the eligible children to enroll EPSDT and receive the services

Identify the Medicaid children population health risk early

Better capture the provided care data and improve the quality

providers improve performance

In memory of Barbara Bridgewater for her passion, insight, courage and dedication to the Medicaid industry.

Barbara was the coauthor of the original abstract for this presentation.

Thank You and Contact Information : Xiaohui Zhang, Ph.D., Chief Scientist & Technology Strategist, STC Xiaohui_zhang@stchome.com Mark Shishida, Executive Vice President, Cognosante Seonho Kim, Chief Architect, ApeniMed, Inc.,

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